A comparative study of Mantoux test and BCG test in diagnosis of childhood tuberculosis

Kripasindhu Chatterjee; Pradyut Kr Mandal; Sk. Rafikul Rahaman; Amit Dutta; Mrinal Kanti Karmakar; Narshima Rao Banoth

doi:10.18203/2349-3291.ijcp20181510

Authors

Kripasindhu Chatterjee Department of Pediatrics, Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, West Bengal, India
Pradyut Kr Mandal Department of Pediatrics, ICARE Institute of Medical Sciences and Research, Banbishnupur, Purba Medinipur, Haldia, West Bengal, India
Sk. Rafikul Rahaman Department of Pediatrics, ICARE Institute of Medical Sciences and Research, Banbishnupur, Purba Medinipur, Haldia, West Bengal, India
Amit Dutta Department of Obstetrics and Gynaecology, Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, West Bengal, India
Mrinal Kanti Karmakar Department of Anatomy, ICARE Institute of Medical Sciences and Research, Banbishnupur, Purba Medinipur, Haldia, West Bengal, India
Narshima Rao Banoth Department of Pathology, ICARE Institute of Medical Sciences and Research, Banbishnupur, Purba Medinipur, Haldia, West Bengal, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20181510

Keywords:

BCG test, Children, Diagnosis, Mantoux test, Tuberculosis

Abstract

Background: India has one of the highest tuberculosis (TB) burdens globally. However, few studies have focused on TB in young children, a vulnerable population, where lack of early diagnosis results in poor outcomes.

Methods: The present study was undertaken to assess the sensitivity and specificity of tuberculin test (Mantoux) and BCG test in diagnosis of childhood tuberculosis and to compare above tests as a diagnostic tool and to assess the impact of factors affecting the test. Mantoux test was done with 1 TU contained in 0.1 ml of PPD R23 with tween 80 solution. BCG test was done using a heat stable freeze-dried vaccine, after fresh reconstitution and injected intradermally in left deltoid region with a tuberculin syringe and 27 G hypodermic needle.

Results: Tuberculous cases were more common in malnourished subjects more so with severe malnutrition. While maximum positivity 89% was obtained with BCG test, it was only 63% with Mantoux test, done with 5TU of PPD-RT-23. BCG was always positive whenever PPD was positive in any group of children. Sensitivity of Mantoux test was around 63% whereas that of BCG test was 89%. BCG test was more significantly associated with disease than tuberculin test (p <0.001).

Conclusions: BCG test is a very sensitive and specific test for diagnosis of childhood tuberculosis. Mantoux test is affected by malnutrition and severity of disease whereas BCG test is affected only minimally. BCG test is more sensitive than Mantoux test (with 5TU PPD RT 23 Tween 80). A BCG induration of ≥10 mm or Mantoux induration ≥15 mm or an accelerated BCG test is indicative of active disease, irrespective of vaccination status of the patient.

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References

Revised National TB Control Programme (RNTCP) Annual Status Report TB India. 2017. Available at https://tbcindia.gov.in/WriteReadData/TB%20India%202017.pdf

WHO. WHO Global tuberculosis report. 2013. Available at http://www.who.int/tb/publications/global_report/gtbr13_executive_summary.pdf.

John TJ, Vashishtha VM, John SM. 50 years of tuberculosis control in India: progress, pitfalls and the way forward. Indian Pediatr. 2013;50(1):93-8.

Jain SK, Ordonez A, Kinikar A, Gupte N, Thakar M, Mave V, et al. Pediatric tuberculosis in young children in India: a prospective study. Biomed Res Int. 2013;2013:783698.

Marais BJ, Hesseling AC, Gie RP, Schaaf HS, Beyers N. The burden of childhood tuberculosis and the accuracy of community-based surveillance data. Int J Tuberc Lung Dis. 2006;10(3):259-63.

Kabra SK, Lodha R, Seth V. Tuberculosis in children: what has changed in last 20 years? Indian J Pediatr. 2002;69(1):S5-10.

Swaminathan S, Rekha B. Pediatric tuberculosis: global overview and challenges. Clin Infect Dis. 2010;50(3):S184-94.

American Thoracic Society. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med. 2000;161:1376-95.

American Thoracic Society/Centers for Disease Control. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med. 2000;161:S221-47.

Menzies D. Interpretation of repeated tuberculin tests. Boosting, conversion, and reversion. Am J Respir Crit Care Med. 1999;159:15-21.

Udani PM, Usha C, Shah PM, Naik PA. BCG test in tuberculosis. Indian Pediatr. 1971;8:143-50.

Desai AB, Vani G, Ahya PN. Diagnostic value of BCG in tuberculosis. Indian Pediatr. 1972;9(12):72-6.

Lothe PS, Gupta SP, Agarwal SP. Evaluation of BCG as a diagnostic test in tuberculous mengititis. Indian Pediatr. 1973;10:7-9.

Rupani MN, Katira MM, Khara RK, Heqdekar VGV, Wagle CS. BCG in diagnosis of childhood tuberculosis. Ped Clin India. 1973;8:43.

Aiyer R, Shekari R. Diagnostic value of BCG vaccination. Ped Clin India. 1973;8:17.

Choudhary VP, Singh MM, Verma IC. BCG and mantoux intradermal test in the diagnosis of tuberculosis. Indian Pediatr. 1974;11;8-9.

Dixit KP, Singh S. BCG test for diagnosis of childhood tuberculosis. Indian Pediatr. 1976;13:687.

Jaiswal S, Bhandari NR. Evaluation of diagnostic value of BCG test in childhood tuberculosis. Indian Pediatr. 1976;13:689.

Bhandari NR, Bhambal SS, Beohar V. Diagnostic value of BCG test in childhood tuberculosis. Indian Pediatr. 1984;21:555-9.

Kapoor RK, Wakhlu I, Gupta PK, Saksena PN. Diagnostic utility of BCG test in children. J Indian Medical Assoc. 1982;78:177-80.

Chandra P, Harilal KT. Factors affecting efficacy of BCG vaccination. Indian Pediatr. 1977;14(7):77-9.

Rashid A, Qayum S, Anjum R. Evaluation of BCG test in diagnosis of tuberculosis in BCG vaccinated children and its comparison with Mantoux test. Int J Contemp Pediatr. 2016;3:1339-43.

Nabi G. Clinical study of tuberculosis in Kashmiri children below 5 years. Thesis for M.D. Pediatrics Kashmir University. 1978.

Chandra RK. Cell mediated immunity in nutritional imbalance. Pediatr Proc. 1980;39:3088-91.

Chandra RK. Serum thymic hormone activity in PEM. Clin Exp Immunol. 1979; 38:228-30.

Mathur GP, Mathur S, Gupta V. Tuberculosis in children with reference to immunization status: a hospital study. Indian Pediatr. 1991;28:569-70.

Mehta R, Saini L, Mittal SK. A critical evaluation of BCG test applicability in paediatric practice. Indian Pediatr. 1986;23(6):419-28.

Tuberculosis prevention trial. Trial of BCG vaccines in south India for tuberculosis prevention, 1979. Indian J Med Res. 2013;137(3):15.

Saito M, Bautista CT, Gilman RH, Bowering A, Levy MZ, Evans CA. The value of counting BCG scars for interpretation of tuberculin skin tests in a tuberculosis hyperendemic shanty-town, Peru. Int J Tuberculosis Lung Dis. 2004;8(7):842-7.

Udani PM, Somu N. Tuberculosis in children: Clinical features and presentation. In: Childhood Tuberculosis. Lupin Publications;1996:18-20.

Narayan R, Prabhakar S, Thomas S, Kumari SP, Suresh T, Srikantaramu N. A sociological study of awareness of symptoms and action taking of persons with pulmonary tuberculosis (a resurvey). Indian J Tuberculosis. 1979;26(3):136-46.

Datta T, Sen K. BCG versus tuberculin test in the diagnosis of childhood tuberculosis. Indian Pediatr. 1982;19:141-6.